FACULTY FIELD NOTE

FACULTY FIELD NOTE
Date:
Resident:
Supervisor:
Direct observation: oYES oNO
Setting: oOutpatient
oInpatient
oER
oPatient’s home
oPCH
Description
Domain
o Maternal Care
o Care of Children/
Describe the interaction (age, gender, problem):
Adolescents
o Care of Adults
o Care of Elderly
o Palliative Care
o Care of First Nation, Inuit,
Métis
o Care of vulnerable &
underserved
o Behavioral Medicine
Competency
Phase of encounter
99 Core topic:
Comments
Phase:
Assessment Parameter
oFM Expert
oPatient-centered
oSelectivity
oClinical reasoning
oProcedural skill
oCommunicator
oCollaborator
oLeader/Manager
oHealth Advocate
oScholar
oProfessional
Assessment Parameter
oFM Expert
oPatient-centered
oSelectivity
oClinical reasoning
oProcedural skill
oCommunicator
oCollaborator
oLeader/Manager
oHealth Advocate
oScholar
oProfessional
What has been done well:
What could be done differently:
Overall
Performance
o Does not do this well (practice with full supervision)
o Is starting to do this well (practice with supervision on demand)
o Does this well (ready for “unsupervised” practice)
Action Plan
o Flag for review
Supervisor
Signature
Resident
Signature
Please return the signed form to your program assistant
November 18, 2015
99 Core Topics
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
17)
18)
19)
20)
21)
22)
23)
24)
25)
26)
27)
28)
29)
30)
31)
32)
33)
Abdominal Pain
ACLS
Allergy
Anemia
Antibiotics
Anxiety
Asthma
Atrial Fibrillation
Bad News
Behavioral Problems
Breast Lump
Cancer
Chest Pain
Chronic Disease
COPD
Contraception
Cough
Counselling
Crisis
Croup
Deep Venous Thrombosis
Dehydration
Dementia
Depression
Diabetes
Diarrhea
Difficult Patient
Disability
Dizziness
Domestic Violence
Dyspepsia
Dysuria
Earache
34)
35)
36)
37)
38)
39)
40)
41)
42)
43)
44)
45)
46)
47)
48)
49)
50)
51)
52)
53)
54)
55)
56)
57)
58)
59)
60)
61)
62)
63)
64)
65)
66)
Eating Disorders
Elderly
Epistaxis
Family Issues
Fatigue
Fever
Fractures
Gastro-intestinal Bleed
Gender Specific Issues
Grief
Headache
Hepatitis
Hyperlipidemia
Hypertension
Immigrants
Immunization
In Children
Infections
Infertility
Insomnia
Ischemic Heart Disease
Joint Disorder
Lacerations
Learning
Lifestyle
Loss of Consciousness
Loss of Weight
Low-back Pain
Meningitis
Menopause
Mental Competency
Multiple Medical Problems
Neck Pain
67)
68)
69)
70)
71)
72)
73)
74)
75)
76)
77)
78)
79)
80)
81)
82)
83)
84)
85)
86)
87)
88)
89)
90)
91)
92)
93)
94)
95)
96)
97)
98)
99)
Newborn
Obesity
Osteoporosis
Palliative Care
Parkinsonism
PHE/Screening
Personality Disorder
Pneumonia
Poisoning
Pregnancy
Prostate
Rape/Sexual Assault
Red Eye
Schizophrenia
Seizures
Sex
STI
Skin Disorder
Smoking Cessation
Somatization
Stress
Stroke
Substance Abuse
Suicide
Thyroid
Trauma
Travel Medicine
URTI
Urinary Tract Infection
Vaginal Bleeding
Vaginitis
Violent/Aggressive Patient
Well-baby
Phases of Encounter
Hypothesis
History
Physical
Investigation
Diagnosis
Management
Referral
Follow-up
Complete encounter
Assessment Parameters
The CFPC’s Six Dimensions of evaluation and CanMEDS are integrated into field note assessment parameters.
FM Expert
• Patient-centered: Focuses on the patient and his/her context and not on the disease alone
Explores illness - Understands whole person/context – Builds common ground - Builds relationship - Is realistic
• Selectivity: Demonstrates a selective approach, adapting it to the patient and the context
Appropriately focused – Appropriately thorough – Establishes priorities – Distinguishes between urgent and non-urgent
• Clinical reasoning: Gathers and interprets data in order arrive to diagnosis and management.
Generates hypothesis/ differential diagnosis – Gathers data (Hx & Px) – Makes decisions – Sets goals and objectives
• Procedural skill: Demonstrates appropriate technical skills and approaches to procedures.
Decision to act – Informed consent & preparation – Comfort & safety during procedure – Re-evaluation if problems - After care
Communicator: Utilizes effective verbal and non-verbal skills when interacting with patients.
Listening skills – Verbal & written language skills – Non-verbal skills – Culture & age appropriateness – Attitudinal
Collaborator: Communicates and works effectively with colleagues and other professionals.
Listening skills – Verbal & written language skills – Non-verbal skills – Teamwork - Handover
Leader/Manager: Takes responsibility for the delivery of excellent patient care.
Resource allocation – Cost appropriateness – Leadership – Practice Management – Quality improvement
Health Advocate: Seeks to understand needs, speak on behalf of others when required, and support the mobilization of
resources to effect change
Determinants of health – Community resources – Barriers to care
Scholar: Committed to continuous learning and by teaching others, evaluating evidence, and contributing to scholarship
Identifies learning needs – Manages own learning - Integrates evidence – Teaches – Engages in scholarship
Professional: Committed to the well-being of individual patients and society through ethical practice, high personal
standards of behaviour
Responsible/Reliable – Knows limits – Flexible – Evokes Confidence – Caring/Compassionate – Respect/Boundaries –
Collegial – Ethical/Honest – Maintains good balance – Mindful approach
November 18, 2015